1B75

PAY RANGE: 14

MEDICAL CLERK

(Bilingual)

(General)

 (Medical Coding)

(Pharmacy)

GENERAL DEFINITION

          This is specialized clerical work at an advanced level in the Health Department’s Ambulatory Health Services. Employees in this class perform complex and complicated medical clerical work either providing a variety of support services to medical staff including nurses, dentists and physicians for the General specialty, posting payments and reconciling billing errors for the Medical Coding specialty, or processing prescription requests and assisting in the dispensing of medications for the Pharmacy at a Health Center. Work includes serving as receptionist and lead clerical support in a program area such as adult medicine, pediatrics, family planning, pre-natal, dental, etc. for the General specialty. Contacting physicians and other health agencies or insurance companies to clarify and resolve discrepancies and keeping abreast of changes are significant aspects of the work for the Medical Coding specialty and Pharmacy specialty. Employees in this class are supervised by administrative or technical supervisors.

ALLOCATING FACTORS: (The following conditions must be met for a position to be allocated to this class.)

· Employees in this class must perform advanced medical clerical work in the   Health Department’s Ambulatory Heath Services.

TYPICAL EXAMPLES OF WORK (ILLUSTRATIVE ONLY)

ALL SPECIALTIES

Reviews information received for accuracy and correctness.

Prepares queries to physicians and other medical sources to obtain clarification of information received.

Performs related work as required.

BILINGUAL SPECIALTY

Performs the duties described above with members of the English language speaking and designated non‑English language speaking populations.

GENERAL SPECIALTY

          Performs clerical duties relating to patient care; determines patients’ eligibility for care; confirms patient identification and ensures patients meet the residency requirement; assesses patients’ financial liability for services; obtains demographic and insurance information needed to complete registration process; researches insurance eligibility coverage using electronic verification system (EVS) or via Internet; uses Navinet and Promise; promptly and accurately enters insurance information into the billing system to ensure reimbursement; refers uninsured patients to benefits counselors;  maintains records on specialty care referrals on uninsured patients; confirms receipt of report from referring physician so that payment to hospital specialists can be processed.

          Generates an encounter form on every visit and ensures all encounter forms are filled out accurately; at the end of the visit, enters the charges into the practice management system.

          Retrieves a high volume of patient charts prior to scheduled appointments; routes specific charts to designated locations and files charts in numeric order after a patient’s appointment or physician’s review; files results of lab tests and treatment (letters and reports from referring providers) in medical charts; obtains medical records or other information from outside health facilities.

          Understands the eligibility and referral process for insurance and entitlement information; ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other confidentiality laws in order to protect patient privacy when handling records in a crowded work environment; obtains patient signatures on HIPAA forms and informs patients of their rights under HIPAA; determines whether requested medical information is protected or whether it can be released to family members, the legal guardian, other health care providers, lawyers and insurance companies.

Plans and assigns work to lower-level clerical employees, volunteers, and interns; checks work upon completion for accuracy and completeness; trains new employees in work routines.

          Acts as a receptionist to greet patients; answers routine inquiries, monitors patient flow and oversees the reception area; answers telephone calls taking messages or transferring the call as appropriate; schedules appointments, contacts other agencies to arrange for transportation for patients (paratransit) and other routine matters; accesses language line and/or in-person interpreters; handles a high volume of patients and uses judgment when enforcing guidelines such as eligibility; directs patients to the appropriate medical program such as OB/GYN, Pre-Natal or Adult Medicine based on patient care needs; explains health center procedures and regulations to patients, families and health center visitors.

MEDICAL CODING SPECIALTY

Operates interactive personal computer; enters demographic and other medical information; extracts data from data base using non-procedural program language to compose statistical reports; devises format for reports; reviews quality of reports, correcting errors as needed before distributing; prepares weekly and monthly statistical reports for state and federal authorities; maintains a computer-generated mailing list to distribute statistical reports.

Contacts providers, health centers, medical examiner, patients and various other sources to obtain information required to resolve discrepancies.

Generates reports to correct coding errors.

Posts payments received from health insurance providers for medical services provided by City health centers; utilizes electronic remittance to post Medicare, Medicaid, Blue Shield and other third-party commercial carrier payments; reviews Medicare and other insurance benefits reports to reconcile billing errors; identifies claims that were rejected due to billing or information errors; reviews denial codes to determine the specific reason claims were rejected.

Generates reports on rejected claims and procedure code errors; analyzes and corrects the financial error report; performs mathematical computations to determine percentages paid by health insurance providers.

Generates invoices for health care accounts receivable function; performs billing, posting and reconciliation activities.

PHARMACY SPECIALTY

          Assists licensed pharmacists in dispensing drugs and medications prescribed by medical practitioners and/or repackage bulk medications for distribution to various medical facilities; receives original and refill prescriptions from patients; processes prescriptions; retrieves bottles from bins in pre‑packaged form if available; manually counts tablets and capsules, and bottles medication if necessary; reconstitutes liquid medications; evaluates for accurate patient identification.

          Dispenses drugs to tuberculosis patients under the direction of a pharmacist; requests and verifies current validity of patient's prescription plan; instructs patients to have physicians complete forms required to order medications not on formulary; assists pharmacists in maintaining patient profiles and other information necessary for billing; performs additional record keeping functions required for operations of the pharmacy under the direction of the pharmacist.

          Pre-packs medications for health center clinics; ensures that night clinic cart is stocked.

          Receives drug orders from district health centers, disease control program staff and other departmental divisions as required; retrieves electronic orders from the electronic health records interface; repackages bulk medications into smaller quantities; counts tablets and capsules using a pill counting machine; places medication into bottles; prepares labels for bottles; affixes labels to bottles; maintains a log of all repackaged drugs; packs drugs in boxes or bags and indicates contents; notifies medical facilities when orders are ready for pick-up; maintains records of drug orders received and distributed.

          Checks drugs on hand against quantity required; orders drugs from drug supplier, pharmacy storeroom and warehouse; checks deliveries for completeness; shelves drugs after delivery; rotates dated items; sorts outdated merchandise for disposal or return to pharmaceutical drug vendor.

          Answers telephone; responds to routine patient inquiries; utilizes electronic health records interface to check for insurance coverage; may contact insurance companies to obtain additional information about prescription coverage.

          May provide technical direction to student interns.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES

KNOWLEDGE OF:

ALL SPECIALTIES

· medical terminology

· medical office billing processes

· basic arithmetic

· spelling and language skills

GENERAL SPECIALTY

· principles and practices of medical office management and supervision

· the medical facility’s organization and services

· the types and purpose of medical coding for procedures and diagnoses

· health care insurance carriers including managed care, Medicare, fee of service, and indemnity programs

· the basic rules and regulations governing patient care

· medical records associated with the program (dental, adult medicine, pediatrics, family planning, pre-natal, etc)

· applicable legal and administrative requirements pertaining to the release of information

· the Health Insurance Portability and Accountability Act (HIPAA) and other confidentiality laws in order to protect patient privacy

MEDICAL CODING SPECIALTY

· medical coding procedures using ICD-9 manuals (International Classification of Diseases-9)

· the objectives and procedures used in medical record-keeping systems

· interactive personal computer data entry and retrieval procedures

· basic bookkeeping principles and practices

· standard accounting and/or billing procedures of the City

PHARMACY SPECIALTY

· the principles, practices and procedures of the pharmacy field

· the materials and supplies used in the pharmacy field

· the storage of drugs and rotation of stock including the checking and verification of expiration dates

· brand name and generic drug equivalents, properties and interactions

SKILL IN:

ALL SPECIALTIES

· the use of personal computers in report generation and records maintenance

GENERAL SPECIALTY

· the operation of office machines, including automated systems, required by work assignments

· medical billing software packages such as Siemens and insurance verification tools such as Navinet and Promise

· the numeric and alpha filing of patient records

MEDICAL CODING SPECIALTY

· the proofing and verification of machine and computer-produced statements

PHARMACY SPECIALTY

· computer software used in the pharmacy field

ABILITY TO:

GENERAL AND MEDICAL CODING SPECIALTIES

· work independently on difficult or complex clerical tasks

· make varied arithmetic calculations

· express ideas effectively both orally and in writing

GENERAL SPECIALTY

· plan, assign and review the work of lower-level clerical employees, volunteers, and interns

· maintain complex clerical records and prepare a variety of reports

· make judgment decisions where several alternative courses of action are presented

· establish and maintain effective working relationships with associates, other City agencies, and the general public

MEDICAL CODING SPECIALTY

· learn diagnosis and procedure codes associated with medical billing

· learn one or more non-procedural program languages

· prepare statistical reports

· maintain favorable working relationships with representatives of outside agencies, professional and medical personnel, health insurance providers, and other employees

· read, understand and interpret health care and health insurance data

· learn the various regulations related to work assignment

PHARMACY SPECIALTY

· assist in the preparation of pharmaceuticals

· maintain complete and accurate records

· learn to use the necessary equipment for counting and labeling medication

· learn pharmacy drug and supply ordering procedures

· measure medication amounts using the metric system

· understand and follow written and oral instructions

· exercise courtesy and tact when dealing with the public

· speak, read and write in a specified non‑English language and in English fluently for the Bilingual Assignment

MINIMUM ACCEPTABLE TRAINING AND EXPERIENCE (The following statement represents the minimum training and experience standards which will be used to admit or reject applicants for tests. Applications submitted by candidates for this class will be reviewed based on training and experience requirements as approved on 4/17.)

ALL SPECIALTIES

EDUCATION:

          Education equivalent to completion of the twelfth school grade.

GENERAL SPECIALTY

AND
GENERAL EXPERIENCE:

          One year of experience in clerical work.

AND

SPECIFIC EXPERIENCE:

          Two years of experience at the Clerk 2 level or above, performing clerical procedures in Ambulatory Health Services or an outside medical office environment.

MEDICAL CODING SPECIALTY

AND

GENERAL EXPERIENCE:

Two years of experience at the Clerk 2 level or above.

AND

SPECIFIC EXPERIENCE:

One year of full performance level clerical experience in the Health Department performing work in a centralized billing and reimbursement unit, using the appropriate health information software.

PHARMACY SPECIALTY

AND

CERTIFICATION:

          Certification as a Pharmacy Technician by the Pharmacy Technician Certification Board (PTCB) or the Institute for the Certification of Pharmacy Technicians (ICPT) at the time of application.

AND

EXPERIENCE:

          One year of experience assisting a pharmacist in the preparation and dispensing of medications.

ALL SPECIALTIES

OR

          Any equivalent combination of education and experience determined to be acceptable by the Office of Human Resources that has included completion of the twelfth school grade as an educational minimum for the General and Medical Coding specialties, and certification as a Pharmacy Technician as described above for the Pharmacy specialty.

ADDITIONAL REQUIREMENT FOR THE BILINGUAL SPECIALTY

          Sufficient training and/or experience to be able to understand and speak fluently and clearly in English and the designated non‑English language.

PHYSICAL AND MEDICAL REQUIREMENTS

Ability to physically perform the duties and to work in the environmental conditions required of a position in this class.

LICENSES, REGISTRATIONS AND/OR CERTIFICATES

          Certification as a Pharmacy Technician by the Pharmacy Technician Certification Board (PTCB) or the Institute for the Certification of Pharmacy Technicians (ICPT) at the time of application and during tenure of employment as a Medical Clerk for the Pharmacy Specialty only.

Completion of continuing education credits required to maintain Certification as a Pharmacy Technician during tenure of employment as a Medical Clerk for the Pharmacy Specialty only.

Class Established 4/81

Spec Revision:

CSC - 06/09

Ad. Board - 07/09

Spec. Revision:

CSC – 7/15

Ad. Board – 8/15

Spec. Revision:

CSC – 10/15

Ad. Board – 10/15

Latest Spec. Revision:

CSC – 3/17

Ad. Board – 4/17

Change in pay rate:

CSC – 01/24

Ad. Board – 02/24